The Cardiovascular Pathology of Stimulant Overdose Decedents in King County, Washington

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Background: In King County, Washington, the number of methamphetamine related overdose deaths has more than quadrupled since 2010. Compared to the body of evidence on cocaine poisoning, little is known about the risk factors for or pathophysiology of methamphetamine overdose. Aim: To determine the prevalence of acute and chronic cardiovascular pathology among decedents who died from methamphetamine, mixed methamphetamine-heroin, cocaine, and mixed cocaine-heroin overdose compared with a group of heroin overdose decedents. Design: Retrospective case-comparison. Findings: Acute cardiovascular events occurred exclusively among stimulant related deaths. After controlling for sex, weight, age, gender, and race, the methamphetamine group had significantly greater mean heart weight. The cocaine group had significantly greater prevalence of coronary artery disease, cardiomegaly, hypertensive cardiovascular disease, and greater heart weight. The mixed methamphetamine-heroin group was similar to the heroin comparison group across all demographic and cardiovascular variables. Conclusions: Methamphetamine related overdose deaths are strongly associated with greater heart weight in comparison to heroin overdose deaths, but unlike cocaine overdose deaths, they are not associated with chronic cardiovascular pathology.